Provider Demographics
NPI:1164607487
Name:WALSER, CAROL BEEBE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:BEEBE
Last Name:WALSER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 PIERCE ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3108
Mailing Address - Country:US
Mailing Address - Phone:415-441-1166
Mailing Address - Fax:415-441-1095
Practice Address - Street 1:1700 PIERCE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3108
Practice Address - Country:US
Practice Address - Phone:415-441-1166
Practice Address - Fax:415-441-1095
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-05
Last Update Date:2008-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9363103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL93630Medicare PIN